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정답: Docetaxel induced interstitial pneumonitis
환자는 breast cancer 에 대해 docetaxel based chemotherapy를 시행받았고
이후 증상 발생하였습니다.
Chest CT 판독
Diffuse patchy ground glass opacity in both lungs.
No pleural effusion.
IMP: Most likely interstitial pneumonia such as viral or PCP.
수술이 계획되어 있는 상태로, 검사상 다른 감염의 증거가 명확하지 않았으며, breast cancer
cell type이 invasive하여 BAL 등의 검사 진행 없이
Prednisolone 복용하여 치료하였습니다.
1주후 DOE등의 증상은 호전되었고 Steroid tapering 중에 있습니다.
아래는 치료 전후의 사진과 Review 입니다.
Docetaxel induced Interstitial pneumonitis
Multiple reports, acute or subacute
Bilateral
Deveoloping within hours or a few weeks after paclitaxel, docetaxel
Paclitaxel
Acute or subacute diffuse interstitial pneumonia
Pulmonary opacities with peripheral eosinophilia
Acute noncardiogenic pulmonary edema
Docetaxel
Acute or subacute diffuse interstitial pneumonia
ARDS
Pleural effusion
Immune mediated delayed hypersensitivity reaction
Incidence
1-4%( patients with every 3 week schedule)
Impact of dose
Docetaxel, modest dose effect
Higher incidence grade3-4 pulmonary toxicity doses of 100mg/m2
as compared to 60,g/m2
Concomitant drugs
Taxane induced pulmonary toxicity, higher when Taxane + Cytotoxic agents
Cytotoxic agents: gemcitabine
Cisplatin + weekly docetaxel
Radiation + weekly docetaxel
Radiologic appearance
Nonspecific
Increased reticular markings in a patchy or diffuse pattern with or
without GGO
Eosinophil parenchymal infiltration
Organizing pneumonia type reactions
Focal opacities or dense nodules or consolidation with or without
bronchograms
BAL and biopsy
To exclude other precesses such as infection, alveolar hemorrhage, metastasis
BAL: lymphocytosis
Lung biopsy: progressive or severe disease
Histopathology, nonspecific
Treatment
Supportive care
Avoidance of taxane therapy until evidence of pneumonitis has
resolved
Steroid in selected patients
Immunologic mechanism (hypersensitivity pneumonitis)
Acute or subacute presentation
Bronchoconstriction, inhaled bronchodilators
Severe pulmonary toxicity (DOE, desaturation, worsening
clinical status)
Mandatory to exclude infection (ex, BAL)
Prednisone, 40~60mg daily
IV steroid for respiratory failure
- Acute, subacute onset: improved rapidly
- Diffuse alveolar damage progress despite steroid Tx
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